Presentation Description

No description available.

Comments

Posting comment...

Premium member

Presentation Transcript

MANAGAMENT OF MIGRAINE:

MANAGAMENT OF MIGRAINE Shiva B.Phamacy Shiva.pharmacist@gmail.com

Migraine Facts:

Migraine Facts Migraine is one of the common causes of recurrent headaches According to IHS, migraine constitutes 16% of primary headaches Migraine afflicts 10-20% of the general population More than 2/3 of migraine sufferers either have never consulted a doctor or have stopped doing so Migraine is underdiagnosed and undertreated Migraine greatly affects quality of life. The WHO ranks migraine among the world’s most disabling medical illnesses

Burden Of Migraine:

Burden Of Migraine World - 15-20% of women and 10-15% of men suffer from migraine In India, 15-20% of people suffer from migraine Adults – Female: Male ratio is 2 : 1 In childhood migraine, boys and girls are affected equally until puberty, when the predominance shifts to girls. NEJM 2002; 346(4): 257-269; XI Congress of the IHS, 2004

Migraine - Definition:

Migraine - Definition “Migraine is a familial disorder characterized by recurrent attacks of headache widely variable in intensity, frequency and duration. Attacks are commonly unilateral and are usually associated with anorexia, nausea and vomiting” -World Federation of Neurology

Migraine Triggers:

Phases of Acute Migraine:

Phases of Acute Migraine Prodrome Aura Headache Postdrome

PRODROME:

PRODROME Vague premonitory symptoms that begin from 12 to 36 hours before the aura and headache Symptoms include Yawning Excitation Depression Lethargy Craving or distaste for various foods Duration – 15 to 20 min

HEADACHE :

POSTDROME (RESOLUTION PHASE):

POSTDROME (RESOLUTION PHASE) Following headache, patient complains of Fatigue Depression Severe exhaustion Some patients feel unusually fresh Duration: Few hours or up to 2 days

MIGRAINE – CLASSIFICATION :

MIGRAINE – CLASSIFICATION According to Headache Classification Committee of the International Headache Society, Migraine has been classified as: Migraine without aura (common migraine) Migraine with aura (classic migraine) Complicated migraine

MIGRAINE: CLINICAL FEATURES:

Migraine Without Aura Migraine With Aura No aura or Prodrome Aura or prodrome is present Unilateral throbbing headache may be accompanied by nausea and vomiting Unilateral throbbing headache and later becomes generalised During headache, patient complains of phonophobia and photophobia Patient complains of visual disturbances and may have mood variations MIGRAINE: CLINICAL FEATURES

MIGRAINE: DIAGNOSIS:

DIFFERENTIATING COMMON PRIMARY HEADACHES:

DIFFERENTIATING COMMON PRIMARY HEADACHES Strictly unilateral Tension headaches : Do not have the associated features like nausea, vomiting, photophobia, phonophobia. The muscle contraction leads to headache. Headache quality is of a tightening (non-pulsating) quality. Usually bilateral. Intensity is mild or moderate Cluster headaches : Severe unilateral pain. Headache associated with lacrimation, nasal congestion, rhinorrhea, facial sweating or eyelid edema. Pain lasts for 15 to 180 minutes. More common in men

THE TREATMENT APPROACH TO MIGRAINE:

THE TREATMENT APPROACH TO MIGRAINE

LONG-TERM TREATMENT GOALS FOR THE MIGRAINE SUFFERER:

LONG-TERM TREATMENT GOALS FOR THE MIGRAINE SUFFERER Reducing the attack frequency and severity Avoiding escalation of headache medication Educating and enabling the patient to manage the disorder Improving the patient’s quality of life

ANTI-NAUSEANT DRUGS FOR MIGRAINE TREATMENT:

WHY THE NEED FOR PROPHYLAXIS ?:

WHY THE NEED FOR PROPHYLAXIS ? Abortive drugs should not be used more than 2-3 times a week Long-term prophylaxis improves quality of life by reducing frequency and severity of attacks 80% of migraineurs may require prophylaxis

WHEN IS PROPHYLAXIS INDICATED?:

WHEN IS PROPHYLAXIS INDICATED? According to the US Headache Consortium Guidelines, indications for preventive treatment include: Patients who have very frequent headaches (more than 2 per week) Attack duration is > 48 hours Headache severity is extreme Migraine attacks are accompanied by prolonged aura Unacceptable adverse effects occur with acute migraine treatment Contraindication to acute treatment Migraine substantially interferes with the patient’s daily routine, despite acute treatment Special circumstances such as hemiplegic migraine or attacks with a risk of permanent neurologic injury Patient preference

SHIFTING PATIENT FROM IR TO ER:

SHIFTING PATIENT FROM IR TO ER Propranolol extended-release produces low blood levels as compared to immediate-release The dose of the long-acting formulation may need to be higher than the total daily dose of the conventional formulation